Limitations of the Perioperative Cardiovascular Evaluation for Assessing Coronary Artery Disease: A Case Report

INTRODUCTION The American College of Cardiology (ACC) and the American Heart Association (AHA) publ ished pre-operative risk stratification guidelines in 2014. These guidelines have routinely been used by physicians to pre-operatively risk stratify patients. In this case report, a patient was found to have multi-vessel coronary artery disease post-operatively in the setting of unremarkable cardiac work-up preoperatively. This case highlights a limitation of the 2014 ACC/AHA guidelines

Decreased levels of BAG3 in a family with a rare variant and in idiopathic dilated cardiomyopathy.

The most common cause of dilated cardiomyopathy and heart failure (HF) is ischemic heart disease; however, in a third of all patients the cause remains undefined and patients are diagnosed as having idiopathic dilated cardiomyopathy (IDC). Recent studies suggest that many patients with IDC have a family history of HF and rare genetic variants in over 35 genes have been shown to be causative of disease. We employed whole-exome sequencing to identify the causative variant in a large family with autosomal dominant transmission of dilated cardiomyopathy. Sequencing and subsequent informatics revealed a novel 10-nucleotide deletion in the BCL2-associated athanogene 3 (BAG3) gene (Ch10:del 121436332_12143641: del. 1266_1275 [NM 004281]) that segregated with all affected individuals. The deletion predicted a shift in the reading frame with the resultant deletion of 135 amino acids from the C-terminal end of the protein. Consistent with genetic variants in genes encoding other sarcomeric proteins there was a considerable amount of genetic heterogeneity in the affected family members. Interestingly, we also found that the levels of BAG3 protein were significantly reduced in the hearts from unrelated patients with end-stage HF undergoing cardiac transplantation when compared with non-failing controls. Diminished levels of BAG3 protein may be associated with both familial and non-familial forms of dilated cardiomyopathy

Microwaves treat heart disease

IEEE Microwave Magazine, 8(1): pp. 70-75. DOI: http://dx.doi.org/10.1109/MMW.2007.28907

Does antiplatelet therapy enhance myocardial salvage after coronary reperfusion?

AbstractThe aim of this study was to test the hypothesis that either the cyclooxygenase inhibitor aspirin or the thromboxane A2receptor antagonist sulotroban exerts a direct myocardial effect that enhances myocardial salvage worded by reperfusion. Accordingly, 21 anesthetized dogs underwent suture occlusion of the left anterior descending coronary artery. At 2.5 h after occlusion, all dogs received intravenous streptokinase (20,000 U/kg y weight over 30 min) and were randomized to the following groups: group I (n = 7) received no additional treatment, group II (n = 7) received aspirin (5 mg/kg intravenously) and group III (n = 7) received sulotroban (10 mg/kg followed by 10 mg/kg per h intravenously). At 3 h after occlusion, the dogs underwent coronary reperfusion for the next 3 h.Myocardial infarct size as a percent of the hypoperfused zone was similar among dogs in group I (42 ± 8%), group II (41±10%) and group III (45±11 %). The incidence and the extent of myocardial hemorrhage were similar in all three study groups. Infarct size as a percent of the hypoperfused zone was significantly smaller in dogs without hemorrhage irrespective of treatment (35±9%m versus 63±5%, p< 0.01).In conclusion, 1) in the presence of 3 h coronary occlusion and reperfusion, neither a cyclooxygenase inhibitor nor a specific thromboxane A2receptor antagonist enhanced myocardial salvage by means of a direct myocardial effect as comp with reperfusion alone; 2) any potential benefits of combined thrombolytic and antiplatelet therapy are likely to be limited to their vascular effects (for example, reperfusion efficacy and prevention of reocclusion); and 3) myocardial hemorrhage may limit myocardial salvage afforded by coronary reperfusion

A blood pressure waveform sensor for rapid characterization of cardiovascular system

Poster presented at Biomedical Technology Showcase 2006, Philadelphia, PA. Retrieved 18 Aug 2006 from http://www.biomed.drexel.edu/new04/Content/Biomed_Tech_Showcase/Poster_Presentations/Lec_4.pdf.More than 60 million Americans suffer from cardiovascular diseases. We focused on two important complications: Aneurysm and Renal Artery Stenosis. Existing methods to monitor the state of the patient’s cardiovascular system are expensive, invasive and infrequently used. We developed a device based on piezoelectric sensor that captures the blood pressure waveform and is capable of early detection of those diseases. This device is simple, safe, inexpensive and can be combined with standard ambulatory blood pressure tests. The detection, performed by Fourier and Wavelet analysis, helps to characterize arterial blood pressure waveform and detect pathologies. In the future this device may also allow improvement of titration of cardiovascular medications and patient outcome while reducing end-organ complication

Percutaneous coronary intervention of totally occluded coronary venous bypass grafts: An exercise in futility?

Background: Percutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to pose a clinical challenge. Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG. However, contemporary outcomes after SVG intervention have incrementally improved with distal protection devices, intracoronary vasodilators, drug-eluting stents, and prolonged dual antiplatelet therapy. Aim: To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques. Methods: This was a retrospective observational study conducted at a single university hospital. The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG. Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely. Clinical outcomes were assessed at a mean follow-up of 1221 ± 1038 d. The primary outcome was freedom from a major adverse cardiac event (MACE) defined as the occurrence of any of the following: death, myocardial infarction, stroke, repeat bypass surgery, repeat PCI, or graft reocclusion. Results: The study group included 29 men and 6 women with a mean age of 69 ± 12 years. Diabetes was present in 14 (40%) patients. All patients had Canadian Heart Classification class III or IV angina. Clinical presentation was an acute coronary syndrome in 34 (97%) patients. Mean SVG age was 12 ± 5 years. Estimated duration of occlusion was acute (\u3c 24 h) in 34% of patients, subacute (\u3e 24 h to 30 d) in 26%, and late (\u3e 30 d) in 40%. PCI was initially successful in 29/35 SVG occlusions (83%). Total stent length was 52 ± 35 mm. Intraprocedural complications of distal embolization or no-reflow occurred in 6 (17%) patients. During longer term follow-up, MACE-free survival was only 30% at 3 years and 17% at 5 years. Conclusion: PCI of totally occluded SVG can be performed with a high procedural success rate. However, its clinical utility remains limited by poor follow-up outcomes